Provider Demographics
NPI:1407996598
Name:CUBA INDEPENDENT SCHOOLS
Entity Type:Organization
Organization Name:CUBA INDEPENDENT SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRESPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-289-3211
Mailing Address - Street 1:# 50 COUNTY ROAD. 13
Mailing Address - Street 2:P.O. BOX 70
Mailing Address - City:CUBA
Mailing Address - State:NM
Mailing Address - Zip Code:87013-0070
Mailing Address - Country:US
Mailing Address - Phone:505-289-3211
Mailing Address - Fax:505-289-0437
Practice Address - Street 1:# 50 COUNTY ROAD. 13
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013-0070
Practice Address - Country:US
Practice Address - Phone:505-289-3211
Practice Address - Fax:505-289-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-10-15
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-10-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty